Diagnóstico das reações imediatas aos meios de contraste iodados: revisão da literatura
Diagnosis of immediate reactions to iodinated contrast media: a review
Mara M. R. Felix; Maria Fernanda Malaman; Luis Felipe C. Ensina
Resumo
As reações adversas aos meios de contraste são comuns e incluem as reações de hipersensibilidade alérgicas e não-alérgicas. As reações de hipersensibilidade são denominadas imediatas quando ocorrem em até 1h após a administração do contraste, e têm se tornado menos frequentes com o uso de compostos não-iônicos. Além do tipo de contraste, a história de reação prévia é um fator de risco importante para recorrência destas reações. As principais manifestações clínicas são cutâneas, como urticária e/ou angioedema, porém quadros graves de anafilaxia também podem ocorrer. O diagnóstico correto, através da história e testes cutâneos, pode auxiliar na prevenção de novas reações. Além disso, a identificação do paciente sob risco, e a minimização deste risco através da utilização de outros métodos radiológicos ou do uso de contrastes alternativos, pode ser útil na redução da incidência destas reações. Outra medida profilática que pode ter impacto positivo é a utilização das pré-medicações. O objetivo deste artigo foi fornecer uma revisão atualizada da abordagem às reações de hipersensibilidade imediatas aos meios de contraste iodados, através da busca de artigos originais, revisões e consensos indexados nas bases bibliográficas LILACS e MEDLINE.
Palavras-chave
Abstract
Adverse reactions to iodinated contrast media are common and include allergic and non-allergic hypersensitivity reactions. Hypersensitivity reactions are considered immediate when they occur within 1 hour after contrast administration; these reactions have become less frequent with the use of nonionic compounds. In addition to type of contrast, history of a previous reaction is an important risk factor for recurrence. The main clinical manifestations of immediate reactions to iodinated contrast media are cutaneous, e.g., urticaria and/or angioedema, but severe anaphylaxis may also occur. Accurate diagnosis based on clinical history and skin tests can help prevent subsequent reactions. Moreover, the identification of patients at risk and the adoption of measures to minimize risk, e.g. the use of other radiological methods or alternative contrast media, can be useful in reducing the incidence of such reactions. Another prophylactic measure that may have a positive impact is the use of premedication. The objective of this article was to provide an updated review of the approach to immediate hypersensitivity reactions to iodinated contrast media, through the search of original articles, reviews and consensus documents indexed in the LILACS and MEDLINE databases.
Keywords
References
1. Brockow K. Immediate and delayed reactions to radiocontrast media: Is there an allergic mechanism? Immunol Allergy Clin N Am. 2009;29:453-68.
2. Christiansen C. X-ray contrast media: an overview. Toxicology. 2005;209(2):185-7.
3. Pasternak JJ, Williamson EE. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clin Proc. 2012;87(4):390-402.
4. Brockow K, Christiansen C, Kanny G, et al. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005;60:150-8.
5. Katayama H, Yamaguchi K, Kozuka T, et al. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175:621-8.
6. Wolf GL, Arenson RL, Cross AP. A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: Comparison of adverse effects. Am J Roentgenol. 1989;152:939-44.
7. Caro JJ, Trindade E, McGregor M. The risks of death and of severe nonfatal reactions with high- VS low-osmolality contrast media: a meta-analysis. Am J Roentgenol. 1991;156:825-32.
8. Greenberger PA. Drug Allergy: Part B. Allergic reactions to individual drugs: low molecular weight. In: Patterson’s Allergic Diseases. 7th Ed. Lippincott Williams & Wilkins; 2009. p. 276-303.
9. Wolf GL, Mishkin MM, Roux SG, et al. Comparison of the rates of adverse drug reactions. Ionic contrast agents, ionic agents combined with steroids, and nonionic agents. Invest Radiol. 1991;26:404‑10.
10. Liccardi G, Lobefalo G, Di Florio E, et al. Strategies for the prevention of asthmatic, anaphylatic and anaphylactoid reactions during the administration of anesthetics and/or contrast media. J Investig Allergol Clin Immunol. 2008;18(1):1-11.
11. Ho J, Kingston RJ, Young N, et al. Immediate hypersensitivity reactions to IV non-ionic iodinated contrast in computed tomography. Asia Pac Allergy. 2012;2:242-7.
12. Schopp JG, Iyer RS, Wang CL, et al. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol. 2013;20:299-306.
13. Kobayashi D, Takahashi O, Ueda T, et al. Risk factors for adverse reactions from contrast agents for computed tomography. BMC Medical Informatics and Decision Making. 2013;13:18.
14. Brockow K, Romano A, Aberer W, et al. Skin testing in patients with hypersensitivity reactions to iodinated contrast media: a European multicenter study. Allergy. 2009;64:234-41.
15. Schnyder B, Pichler WJ. Mechanisms of drug-induced allergy. Mayo Clin Proc. 2009;84(3):268-72.
16. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105:259-73. Referências
17. Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy. 2014;69:420-37.
18. Idee JM, Pines E, Prigent P, et al. Allergy-like reactions to iodinated contrast agents: a critical analysis. Fundam Clin Pharmacol. 2005;19:263-81.
19. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1:466-9.
20. Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. Allergy. 1999;54:999-1003.
21. Brockow K, Garvey LH, Aberer W, et al. Skin test concentrations for systemically administered drugs – an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702-12.
22. Brockow K, Ring J. Anaphylaxis to radiographic contrast media. Curr Opin Allergy Clin Immunol. 2011;11:326-31.
23. Trcka J, Schmidt C, Seitz CS, et al. Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol. 2008;190(3):666-70.
24. Goksel O, Aydin O, Atasoy C, et al. Hypersensitivity reactions to contrast media: prevalence, risk factors and the role of skin tests in diagnosis – a cross-sectional survey. Int Arch Allergy Immunol. 2011;155(3):297-305.
25. Dewachter P, Laroche D, Mouton-Faivre C, et al. Immediate reactions following iodinated contrast media injection: a study of 38 cases. Eur J Radiol. 2011;77(3):495-501.
26. Hausmann OV, Gentinetta T, Bridts CH, Ebo DG. The basophil activation test in immediate-type drug allergy. Immunol Allergy Clin N Am. 2009;29:555-66.
27. Song WJ, Chang YS. Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity. Asia Pac Allergy. 2013;3(4):266-80.
28. Pinnobphun P, Buranapraditkun S, Kampitak T, et al. The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media. Ann Allergy Asthma Immunol. 2011;106:387-93.
29. Salas M, Gomez F, Fernandez TD, et al. Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy. 2013;68:1203-6.
30. Chiriac AM, Demoly P. Drug provocation tests: up-dated and novel approaches. Allergy Asthma Clin Immunol. 2013;9(1):12.
31. Pietro-García A, Tomás M, Pineda R, et al. Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing. J Investig Allergol Clin Immunol. 2013;23(3):183-9.
32. Iyer RS, Schopp JG, Swanson JO, et al. Safety essentials: acute reactions to iodinated contrast media. Can Assoc Radiol J. 2013;64:193-9.
33. Segal AJ, Bush WH Jr. Avoidable errors in dealing with anaphylactoid reactions to iodinated contrast media. Invest Radiol. 2011;46(3):147‑51.
34. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report- Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117:391-7.
35. Simmons FER. Anaphylaxis: Recent advances in assessment and treatment. J Allergy Clin Immunol. 2009;124:625-36.
36. ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. Disponível em: www.acr.org. Acessado: 06/08/2013.
37. Ensina LF, Fernandes FR, Di Gesu G, Malaman MF, et al. Reações de hipersensibilidade a medicamentos – parte II. Rev Bras Alerg Imunopatol. 2009;32(3):74-83.
38. Tramèr MR, von Elm E, Loubeyere P, et al. Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ. 2006;1-6.
39. Delaney A, Carter A, Fisher M. The prevention of anaphylactoid reactions to iodinated radiological contrast media: a systematic review. BMC Medical Imaging. 2006,6:2.
Submitted date:
10/11/2013
Accepted date:
08/27/2014
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